Organization
GENAHEALTH PHARMACY INC
Active
Other names
GENAHEALTH PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA ROSE KISELYUK PHARM D (PRESIDENT/CEO)
(818) 798-3314
Entity
Organization
Contact information
Practice address
18107 SHERMAN WAY STE 202, RESEDA, CA 91335-8802
(818) 798-3314
(818) 614-9074
Mailing address
18107 SHERMAN WAY STE 202, RESEDA, CA 91335-8802
(818) 798-3314
(818) 614-9074
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PHY58685
BOARD OF PHARMACY
CA
Enumeration date
10/18/2022
Last updated
10/18/2022
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